Charvay Jones

• Scheduling appointments utilizing Mueller proprietary software and a scheduling calendar

• Contact with Policyholders, Agents & Designated Contacts

• Complete telephone interviews regarding policy information

• Updating the appropriate survey with action taken

• Close Out Non-Productive Surveys - The SA will close out the workflow of surveys that are refusals by Policyholders, or Lack of Responses by Policyholders

• Other duties as assigned

• Billing

• Working incoming cases via fax to process coverage requests from members or prescribers.
• Conducting outreach to patients and providers, and obtaining additional information needed to process requests.
• Researching and correcting any issues found in the overall process.
• Raising issues to Organization Determination Clinical Pharmacists and Management team as needed.
• Reading, analyzing, and interpreting general business correspondence, technical procedures, and governmental regulations.
• Solving practical problems and dealing with multiple concrete variables in standardized situations.
• Performing basic mathematical calculations.
• Ensuring all cases are properly closed
• Ability to interpret a variety of work instructions provided through multiple mediums
• Ability to anticipate needs and resolve issues with
• urgency and to meet quality and production standards

• Enter patient demographics and medical history into the database

• Update medical records with new information as needed
• Ensure accuracy and completeness of all data entered
• Adhere to HIPAA guidelines and maintain patient confidentiality

Sort and organize large datasets in spreadsheets.
• Review forms for errors or deficiencies and make corrections using Adobe.
• Perform accurate and efficient data entry.
• Upload, download, and edit electronic files as needed.
• Communicate effectively with employer groups, brokers, and internal business partners through email, phone calls, and virtual meetings.

• Performs member or provider related administrative support which may include benefit verification, authorization creation and management, claims inquiries and case documentation.
  • Reviews authorization requests for initial determination and/or triages for clinical review and resolution.
  • Provides general support and coordination services for the department including but not limited to answering and responding to telephone calls, taking messages, letters and correspondence, researching information and assisting in solving problems.
  • Assists with reporting, data tracking, gathering, organization and dissemination of information such as Continuity of Care process and tracking of Peer to Peer reviews.

• As a Level II Patient Service Representative, utilizes advanced skill set to perform all duties of the Patient Service Representative I and serves as resource and mentor for lower level representatives
• Handles the more complex issues arising through incoming calls
• Under direct supervision, plays an expanded and advanced level role in the creation of superior access for patients
• Duties include but are not limited to handling incoming patient inquires and assisting patients in the management of appointments/care
• Through a variety of support duties that facilitate the work of an interdisciplinary coordinated care delivery model, the Patient Service Representative plays an integral role in the support of our patients
• Provides extraordinary customer service and strong problem solving skills to strengthen the patient/clinician relationship
• Processed patient admissions, registrations, transfers, and discharges according to established procedures.
• Assisted with scheduling outpatient appointments.
• Responded to patient inquiries regarding billing or financial matters.
• Ensured accuracy of all data entered into computer system.
• Scanned documents into electronic medical records system.
• Answered phones promptly in a professional manner.

• Maintains effective systems to support the timely release of accurate information to diverse clients.
• Responsible for the prescription intake of all programs specific to non-dispensing pharmacy prescriptions across multiple prescription brands.
• Logs information into the appropriate pharmacy database and triages all prescriptions to the appropriate dispensing pharmacy.
• Pharmacist support related to prescription processing as needed.
• May assist with inbound call volume as received.
• Work closely with Pharmacists and other Pharmacy Technicians.
• Run eligibility checks and test claims as needed for patient prescriptions as required.
• Distribute prescriptions to appropriate Reimbursement Specialists and appropriate stakeholders.
• Maintains and promotes a positive and professional working relationship with associates and management.
• Complies with all appropriate program policies and procedures.
• Works on problems of moderate scope where analysis of data requires a review of a variety of factors. Exercise judgment within defined standard operating procedures to determine appropriate action.
• Typically receives little instruction on day-to-day work, general instructions on new assignments.
• Perform related duties as assigned.